- Alcoholics, the heaviest
of drinkers, are also the heaviest of smokers.
- A recent study found
that nicotine is especially rewarding in smokers in recovery from
alcoholism compared to smokers with no history of alcoholism.
- Smokers who are former
alcoholics probably require special help to deal with nicotine
addiction when they try to stop smoking.
It’s no secret that
"smokers drink and drinkers smoke." In fact, the heaviest
drinkers are also the heaviest smokers. According to information
provided by the National Institute on Alcohol Abuse and Alcoholism,
between 80 and 95 percent of alcoholics smoke cigarettes, a rate that is
three times higher than among the population as a whole. Approximately
70 percent of alcoholics are heavy smokers (meaning they smoke
more than one pack a day), compared with just 10 percent of the general
population. A study in the November issue of Alcoholism: Clinical
& Experimental Research closely examines this association to see
if smokers with a past history of alcoholism are more nicotine dependent
than smokers with no such history.
"There are many
theories of why smoking and alcoholism go together," said John R.
Hughes, professor of psychiatry at the University of Vermont/Fletcher
Allen Healthcare and lead author of the study. "Some studies
suggest that the same genes that predispose people to alcoholism also
predispose them to smoking. Some have thought there is an ‘addictive
personality’ that becomes addicted to many things, but research
suggests this is not so. Another idea is that since smoking stimulates
and alcohol relaxes, smokers use alcohol to prevent over-stimulation
from smoking and alcoholics use cigarettes to prevent sedation. Yet
another idea is that those who become alcoholics are people who use
substances for the drugs within them, for example, to get high or to
cope with life. This theory would predict that alcoholic smokers use
tobacco mostly for the nicotine in it."
Hughes’ study examined if
smokers with a past history of alcoholism would report more positive
effects from nicotine alone (using nicotine gum) and would
self-administer nicotine more often and in greater amounts than smokers
without this history. What they found was that smokers with a history of
alcoholism did not report more positive effects from nicotine
itself, but these smokers did more often choose to use pure
nicotine, and ingested greater levels of nicotine than smokers without
this history. This means that smokers with a history of alcoholism
didn’t necessarily like nicotine more, but they did seem to find
nicotine more rewarding.
"It may seem
unusual," explained Hughes, "that we found a difference
between the self-administration or rewarding effects of nicotine and the
subjective effects or the liking of nicotine. Usually these two go hand
in hand, but not always. In fact, many smokers state they can't
understand their use of cigarettes because they feel they really don’t
get much out of it. Sometimes we can like something but not be able to
express what it is we like about it. It’s like husbands. If you went
by their words, many husbands would seem not to be much in love with
their wives. But if you went by what they do, they would seem very much
Despite the strong
association between smoking and alcoholism, and numerous theories
concerning that association, relatively few studies have examined the
two together. Furthermore, alcoholism treatment professionals have
generally not addressed the issue of smoking cessation, largely because
of the belief that the added stress of quitting smoking might jeopardize
an alcoholic’s recovery.
has been minor until recently," acknowledged Kenneth A. Perkins,
professor of psychiatry at the University of Pittsburgh Medical Center.
"Many in the alcohol field did not feel smoking was an important
problem for alcoholics, that maintaining sobriety was the critical
factor. Most studies in the smoking field would exclude those with
current or past alcohol dependence. Furthermore, funding has typically
come from different agencies – one for alcohol, another for
smoking/nicotine – which allowed studies of alcohol and smoking
to fall through the cracks."
Yet, noted Hughes, recent
data indicates that smoking actually kills more alcoholics than alcohol
does. Indeed, according to the American Cancer Society, smoking is the
most preventable cause of death in American society. Nearly one in five
deaths in the U.S. results from the use of tobacco; more than 400,000
die from smoking in the U.S. each year.
means," said Hughes, "is that we need to get alcoholics to
stop smoking either while stopping their alcohol or soon after. Our
study suggests these smokers especially need to use medications that
fight nicotine dependence, like the patch, gum, an inhaler, or
Zyban." (Zyban is the trade name for an anti-depressant that is
used by some to quit smoking.)
Perkins concurs. "This
study shows us that chronic use of alcohol can induce long-term changes
in the brain's response to nicotine, making nicotine more rewarding and
thus more difficult to quit," he said. "Medications to block
these effects, or counseling to totally avoid nicotine exposure, may be
suggested by these results. Although someone might think that use of
nicotine replacement therapy (NRT) would pose a problem for those with
past history of alcohol, this is not a reasonable concern. NRT is safe
and effective, and someone with alcohol problems should not be concerned
about using NRT to quit smoking. In fact," he added,
"alcoholics are at least as likely to die from smoking as from
alcohol. Treatment for smoking in that population is critical."
Hughes, J.R., Rose, G.L., Callas, P.W.
(2000). Nicotine is More Reinforcing in Smokers With a Past History of
Alcoholism Than in Smokers Without This History. Alcoholism: Clinical
& Experimental Research, November, 24(10), 1633-1638.